How Do Gepants Compare to Other Acute Treatments?
In addition to gepants, other options for treating a migraine attack include over-the-counter pain relievers, triptans, dihydroergotamine, and anti-nausea medicines.
No single medication suits everyone with migraine; treatment depends on different factors, including symptoms, medical history, other medications being used, and access.
Gepants are a strong alternative to older migraine medicines, says Pak. “They are considered when patients have not responded to more traditional medications, such as triptans,” he says.
They are also an option when people can’t take triptans, such as people who have had a heart attack or stroke, or those who have had significant side effects on other migraine medications, he says.
“Gepants can also be considered a first-line treatment, depending on the patient,” says Pak.
Efficacy
For many people, gepants effectively stop a migraine attack, even in people who haven’t had success with other acute treatments.
Ubrogepant In a 52-week extension study, ubrogepant led to freedom from pain after two hours in 23 to 25 percent of attacks and pain relief after two hours in about 65 to 68 percent of attacks. It worked even better when taken early — while pain was still mild — with two-hour pain freedom rising to about 51 to 54 percent.
Rimegepant Rimegepant has shown sustained efficacy as an acute treatment in long-term studies. A review also found that it worked about as well in people with prior triptan failure as it did in current triptan users and people who had never used a triptan, based on two-hour pain freedom and relief of the most bothersome symptom.
Zavegepant The nasal spray zavegepant can relieve migraine pain within two hours and may keep helping for up to 48 hours. Nasal delivery may be especially useful for people who have nausea or vomiting during an attack, when taking a pill can be harder.
Side Effects
Oral gepants can cause dry mouth, nausea, and sleepiness, while zavegepant can cause taste changes, nasal discomfort, and throat irritation.
Cost
Depending on your prescription insurance coverage, cost may be an issue. Several triptans are available as generics, which tend to be much less expensive than brand-name drugs. Gepants are newer and may still come with insurance hurdles or high copays.
“Traditionally, people had to try other therapies first before gepants were approved by their insurance,” says Jarrard. However, that has started to change, and some insurance plans are covering them without requiring other therapies first, he says.
“If you have a high copay, some of the manufacturers offer savings cards to help with the cost,” says Pak.
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